Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Can J Neurol Sci. 2011 Sep;38(5):741-6. doi: 10.1017/s0317167100054123.
The "chronic cerebrospinal venous insufficiency" or "CCSVI" hypothesis, namely that multiple sclerosis (MS) is caused by abnormalities in the azygous and internal jugular veins with subsequent alterations in venous hemodynamics in the central nervous system, has been a dominant topic in MS care in Canada over the past year. Although there is no methodologically rigorous evidence to support this hypothesis presently, a considerable number of MS patients have undergone endovascular CCSVI procedures. Such procedures include angioplasty or stent placement in jugular and azygous veins. The safety and efficacy of these procedures is unknown, but not without risk.
Chart and patient review of five patients with confirmed MS followed in Calgary were undertaken after patients came to medical attention by referral or admission secondary to complications believed to be associated with CCSVI procedures.
Complications upon investigation and review included internal jugular vein stent thrombosis, cerebral sinovenous thrombosis, stent migration, cranial nerve injury and injury associated with venous catheterization.
As the debate about CCSVI and its relationship to MS continues, the complications and risks associated with venous stenting and angioplasty in jugular and azygous veins are becoming clearer. As increasing numbers of MS patients are seeking such procedures, these five cases represent the beginning of a wave of complications for which standardized care guidelines do not exist. Our experience and that of our colleagues will be used to develop guidelines and strategies to monitor and manage these patients as their numbers increase.
“慢性脑脊髓静脉功能不全”或“CCSVI”假说，即多发性硬化症（MS）是由奇静脉和颈内静脉异常引起的，随后导致中枢神经系统静脉血液动力学改变，这在过去一年中一直是加拿大 MS 护理的主要话题。尽管目前没有严格的方法学证据支持这一假说，但相当多的 MS 患者已经接受了血管内 CCSVI 手术。这些手术包括颈内静脉和奇静脉的血管成形术或支架置入术。这些手术的安全性和疗效尚不清楚，但并非没有风险。
对在卡尔加里确诊为 MS 的五名患者进行了图表和患者回顾，这些患者是因疑似与 CCSVI 手术相关的并发症而转诊或入院后接受治疗的。
调查和审查发现的并发症包括颈内静脉支架血栓形成、脑静脉窦血栓形成、支架移位、颅神经损伤和与静脉置管相关的损伤。
随着对 CCSVI 及其与 MS 关系的争论不断，颈内静脉和奇静脉支架置入和血管成形术相关的并发症和风险变得更加清晰。随着越来越多的 MS 患者寻求此类手术，这五例病例代表了尚无标准化护理指南的并发症浪潮的开始。我们的经验和我们同事的经验将用于制定指南和策略，以监测和管理这些患者，因为他们的数量增加。
